Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PMG Eagle Point Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
10830 HIGHWAY 62, EAGLE POINT, OR 97524-9516
(541) 830-4060
(541) 830-4090
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 830-4060
(541) 830-4090
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500688628
—
OR
Enumeration date
07/01/2015
Last updated
11/19/2025
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